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No ideal procedure found for large knee lesions in young patients
Autologous chondrocyte implantation, patellofemoral arthroplasty and osteochondral allografting had “unpredictable results” in patients aged 50 years or younger with advanced patellofemoral cartilage lesions, according to this PubMed review.
“We concluded that a long-term beneficial effect might not occur in one of three [autologous chondrocyte implantation] ACI and [patellofemoral arthroplasty] PFA procedures, and in two of three [osteochondral allografting] OA procedures,” Frank R. Noyes, MD, and Sue D. Barber-Westin, BS, of the Cincinnati Sports Medicine and Orthopaedic Center, wrote in their study abstract. “We were unable to determine an ideal surgical procedure to treat large, symptomatic patellar lesions in patients 50 years or younger.”
The investigators included 18 studies with 828 patients (840 knees) in their review. Eleven studies focused on ACI; five on PFA and two on OA. According to the abstract, none of the studies had a control group or randomized design, and four studies had greater than 10-years follow-up.
“When taking into account knees that either failed or had fair/poor function, the percentage of patients who failed to achieve a benefit averaged 22% after PFA and 53% after OA and ranged from 8% to 60% after ACI,” the authors wrote. They also noted that all of the procedures studied had complication and reoperation rates that were “unacceptable.”
Disclosure: The authors have no relevant financial disclosures.